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Singh R, Pathi D, Priyanka, Diksha. An Uncommon Presentation of a Ruptured Tubal Ectopic Pregnancy With Broad Ligament Hematoma. Cureus 2025; 17:e81605. [PMID: 40330403 PMCID: PMC12051073 DOI: 10.7759/cureus.81605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2025] [Indexed: 05/08/2025] Open
Abstract
Broad ligament hematomas are rare in obstetrics. These hematomas typically result from vaginal, cervical, or uterine tears that extend to the uterine or vaginal arteries. Although cases of intestinal ectopic pregnancies presenting as broad ligament hematomas with no intraperitoneal collection have been reported, no cases involving broad ligament hematomas along with hemoperitoneum following ampullary ruptured ectopic pregnancy have been documented. Internal iliac artery ligation (IIAL) is particularly useful in broad ligament hematomas. So, we present a case of ruptured ampullary ectopic pregnancy with both intraperitoneal collection and broad ligament hematoma managed by salpingectomy and bilateral IIAL.
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Affiliation(s)
- Ritu Singh
- Obstetrics and Gynecology, Kurji Holy Family Hospital, Patna, IND
| | | | - Priyanka
- Obstetrics and Gynecology, Kurji Holy Family Hospital, Patna, IND
| | - Diksha
- Obstetrics and Gynecology, Kurji Holy Family Hospital, Patna, IND
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Oukili H, Benlghazi A, Benmoussa M, Outaghyame O, Elhassani MM, Kouach J. Arteriovenous malformation associated with trophoblastic retention post-cesarean section: A case report and review. Int J Surg Case Rep 2024; 125:110620. [PMID: 39579632 PMCID: PMC11618002 DOI: 10.1016/j.ijscr.2024.110620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 11/12/2024] [Accepted: 11/13/2024] [Indexed: 11/25/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Uterine arteriovenous malformations are a rare but potentially life-threatening condition. They may be congenital or acquired and should be suspected in cases of severe or persistent uterine hemorrhage. CASE PRESENTATION We present the clinical case of a 32-year-old woman who suffered from bleeding after a spontaneous miscarriage. Uterine arteriovenous malformation with trophoblastic retention was suspected on ultrasound and Doppler examination. Magnetic resonance imaging confirmed the diagnosis, leading to embolization of both uterine arteries, followed by operative hysteroscopy to remove the retained tissue, with a favorable outcome. CLINICAL DISCUSSION Uterine arteriovenous malformation is rare, with fewer than 100 cases reported in the literature (1). It is a potentially fatal condition due to the heavy bleeding that patients may experience. Color Doppler ultrasound (US) is a non-invasive method for initially diagnosing this rare condition, which can be confirmed by diagnostic angiography. A conservative approach or embolization is the preferred treatment to avoid hysterectomy in patients of childbearing age. CONCLUSIONS This case report emphasizes the use of ultrasound and MRI to diagnose a uterine AVM in a patient of childbearing age who presented with post-partum retention of products. It also showcases our experience with embolization in this patient, which allowed her to preserve her fertility.
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Affiliation(s)
- Houssine Oukili
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V, Rabat, Morocco
| | - Abdelhamid Benlghazi
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V, Rabat, Morocco.
| | - Meryem Benmoussa
- Department of Radiology Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V, Rabat, Morocco
| | - Oussama Outaghyame
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V, Rabat, Morocco
| | - Moulay Mehdi Elhassani
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V, Rabat, Morocco
| | - Jaouad Kouach
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V, Rabat, Morocco
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Brown SR, Roane B, Caridi TM, Straughn JM, Gunn AJ. Short-term outcomes of uterine artery embolization for urgent or emergent abnormal uterine bleeding. Abdom Radiol (NY) 2023; 48:2443-2448. [PMID: 37145314 DOI: 10.1007/s00261-023-03928-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To evaluate the outcomes of uterine artery embolization (UAE) for patients with urgent or emergent abnormal uterine bleeding (AUB). MATERIALS AND METHODS Retrospective review of all patients from 1/2009-12/2020 who were treated urgently or emergently with UAE for AUB. Urgent and emergent cases were defined as those requiring inpatient admissions. Demographic data were collected for each patient including hospitalizations related to bleeding and length of stay (LOS) for each hospitalization. Hemostatic interventions other than UAE were collected. Hematologic data were collected before and after UAE including hemoglobin, hematocrit, and transfusion products. Data specific to the UAE procedure included complication rates, 30-day readmission, 30-day mortality, embolic agent, site of embolization, radiation dose, and procedure time. RESULTS 52 patients (median age: 39) underwent 54 urgent or emergent UAE procedures. The most common indications for UAE were malignancy (28.8%), post-partum hemorrhage (21.2%), fibroids (15.4%), vascular anomalies (15.4%), and post-operative bleeding (9.6%). There were no procedure-related complications. Following UAE, 44 patients (84.6%) achieved clinical success and required no additional intervention. Packed red blood cell transfusion decreased from a mean of 5.7 to 1.7 units (p < 0.0001). Fresh frozen plasma transfusion decreased from a mean of 1.8 to 0.48 units (p = 0.012). 50% of patients received a transfusion prior to UAE, while only 15.4% were transfused post-procedure (p = 0.0001). CONCLUSIONS Emergent or urgent UAE is a safe and effective procedure to control AUB hemorrhage secondary to a variety of etiologies.
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Affiliation(s)
- S Rodes Brown
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL, NHB62335249, USA
| | - Brandon Roane
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Ave S, Birmingham, AL, WIC1025035233, USA
| | - Theresa M Caridi
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL, NHB62335249, USA
| | - J Michael Straughn
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6th Ave S, Birmingham, AL, WIC1025035233, USA
| | - Andrew J Gunn
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL, NHB62335249, USA.
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Choi J, Shin JH, Chu HH. Transcatheter Arterial Embolization for Palliation of Uterine Body Cancer Bleeding. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:606-614. [PMID: 37324986 PMCID: PMC10265241 DOI: 10.3348/jksr.2022.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/07/2022] [Accepted: 08/06/2022] [Indexed: 06/17/2023]
Abstract
Purpose This study aimed to evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for bleeding due to uterine body cancer. Materials and Methods In this retrospective study, six patients with varying types of uterine body cancer who underwent TAE for bleeding control were investigated. Angiographic findings, cross-sectional images, TAE details, and clinical outcomes were studied. Technical and clinical success rates were calculated. Results The identified patients had endometrioid adenocarcinoma, sarcoma, and gestational trophoblastic neoplasia, and most were patients with advanced-stage cancer. In four patients, tumor bleeding presented as vaginal bleeding. Technical success was achieved in all seven TAE procedures in six patients. Two patients with recurrent masses who had undergone hysterectomy presented with hematochezia, and TAE was able to provide technical success in these patients as well. The clinical success rate was 50%, indicating bleeding control for > 1 week. Rebleeding was directly associated with death in one patient. On the following day, mild fever was observed in one patient. Conclusion TAE can be considered an effective and safe method of bleeding control for uterine body cancer, especially during critical periods throughout the disease course of patients with inoperable, advanced-stage cancer.
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Timor-Tritsch IE, McDermott WM, Monteagudo A, Calί G, Kreines F, Hernandez S, Stephenson C, Bryk H, D'Antonio F. Extreme enhanced myometrial vascularity following cesarean scar pregnancy: a new diagnostic entity. J Matern Fetal Neonatal Med 2022; 35:5846-5857. [PMID: 33730990 DOI: 10.1080/14767058.2021.1897564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To define, illustrate and to follow-up the diagnosis, pathophysiology and treatment of a subset of the known enhanced myometrial vascularity (EMV): its extreme form, associated with cesarean scar pregnancies (CSP) and with some cases pf placenta accreta spectrum being at increased risk of significant bleeding complications. We also aim to provide guidance to the management of such cases. MATERIAL AND METHODS This is an IRB-approved retrospective observational study of thirteen patients with an extreme form of EMV complicating CSPs. Patient's age, parity, number of cesarean deliveries, initial and time to negative serum hCG levels, primary and secondary diagnoses, blood flow peak systolic velocities, primary and secondary treatments, uterine artery embolization and outcomes were recorded. RESULTS Gestational ages ranged 6-11 weeks at initial presentation. Initial serum hCG was 20.0-102.48 mIU/L (mean 44.4 mIU/L). Diameter of EMV reached 20-75 mm (mean 46.8 mm). The mean peak systolic velocity (PSV) was 84.2 cm/s (range 46.7-118.0). Primary treatments were: systemic methotrexate (MTX) alone; D&C alone; MTX and D&C; local and systemic intra-gestational MTX injection; double cervical ripening balloon with systemic MTX; misoprostol and D&C; emergent UAE. UAE and hysterectomy were the two main secondary treatments in 10 women except 1 having a D&C after UAE, and in 1 the lesion regressed without secondary treatment. Mean time to nonpregnant hCG levels was 21-122 days (mean 67.2). Mean follow-up was 110.2 days (range 26-160). Ten women were treated with UAE, 6 had one, 3 had two embolizations. Two women had hysterectomies, one of these for persistent bleeding. Based upon the common denominators of the clinical and the US pictures, our definition of extreme EMV is sustained form of EMV associated with treated or untreated CSP, with peak systolic velocities of blood flow over 50 cm/s, slow return or plateauing serum hCG, with or without clinically significant vaginal bleeding, unresponsive to initial or secondary treatment requiring uterine artery embolization or hysterectomy. CONCLUSION The EMV developing in the background of retained placental tissue associated with CSP differs following the normal regression of the physiologically re-modelled, dilated vascular bed from the faulty "disrepair" of the vessel wall in in treated or untreated CSPs. The "threatening" appearance of the above EMVs warranted the term "extreme", creating their separate new sub-category." Extreme forms of CSP-related EMV pose significant diagnostic and management challenges. Prompt recognition and intervention, the proactive use of UAE, can maximize the outcome of women affected by this "extreme" form of EMV enabling to preserve reproductive potential. Obstetricians, gynecologists and interventional radiologists should be aware of this form of severe vascular complication.
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Affiliation(s)
- Ilan E Timor-Tritsch
- Department of Obstetrics and Gynecology, NYU Langone Health, NYU School of Medicine, New York, NY, USA
| | | | - Ana Monteagudo
- Department of Obstetrics, Gynecology and Reproductive Science, Carnegie Imaging for Women, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Giuseppe Calί
- Department of Obstetrics and Gynaecology, Arnas Civico Hospital, Palermo, Italy
| | - Fabiana Kreines
- Department of Obstetrics and Gynecology, NYU Langone Health, NYU School of Medicine, New York, NY, USA
| | - Sasha Hernandez
- Department of Obstetrics and Gynecology, NYU Langone Health, NYU School of Medicine, New York, NY, USA
| | | | - Hillel Bryk
- Department of Radiology, NYU School of Medicine, New York, NY, USA
| | - Francesco D'Antonio
- Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Mathieu E, Riethmuller D, Delouche A, Sicot M, Teyssier Y, Finas M, Guillaume B, Thony F, Ferretti G, Ghelfi J. Management of Symptomatic Vascularized Retained Products of Conception by Proximal Uterine Artery Embolization with Gelatin Sponge Torpedoes. J Vasc Interv Radiol 2022; 33:1313-1320. [PMID: 35868595 DOI: 10.1016/j.jvir.2022.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/02/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of temporary proximal uterine artery embolization (UAE) for the treatment of highly vascularized retained products of conception (RPOCs). MATERIALS AND METHODS This retrospective analysis included women who underwent treatment for vaginal bleeding after abortion, miscarriage, or delivery, with highly vascularized RPOCs detected by Doppler ultrasound (US) (ie, presence of an enhanced myometrial vascularity, a low resistance index of <0.5, and a peak systolic velocity of ≥0.7 m/s). A unilateral or bilateral embolization with torpedoes of gelatin foam was performed. From November 2017 to January 2021, 24 women with a median age of 30 years (interquartile range, 26.0-34.5 years) with symptomatic highly vascularized RPOCs were included. Clinical success was defined as bleeding arrest between the UAE and 1-month follow-up. Technical success was defined as the complete obstruction of at least 1 uterine artery supplying vascular abnormalities. The safety of the procedure according to the classification of the Society of Interventional Radiology and evolution of lesions on US were also reported. RESULTS Technical success was achieved in all 24 (100%) patients, with bilateral arterial embolization in 19 (79%) patients and unilateral embolization in 5 (21%) patients. Clinical success was achieved in all 24 (100%) patients. Five patients still had uterine retention at the 1-month follow-up, including 2 patients with highly vascularized RPOCs. Two patients benefited from hysteroscopy, and 3 had noninvasive management. Four minor adverse events were reported (1 patient had infectious endometritis and 3 patients had a postembolization syndrome). CONCLUSIONS Proximal UAE with torpedoes of gelatin foam is safe and effective for the management of symptomatic highly vascularized RPOCs.
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Affiliation(s)
- Eliott Mathieu
- University of Grenoble Alpes, Grenoble, France; Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Didier Riethmuller
- University of Grenoble Alpes, Grenoble, France; Department of Obstetrics and Gynecology, Grenoble Alpes University Hospital, Grenoble, France
| | - Aurélie Delouche
- Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Marie Sicot
- Department of Obstetrics and Gynecology, Grenoble Alpes University Hospital, Grenoble, France
| | - Yann Teyssier
- Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Mathieu Finas
- Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Bénédicte Guillaume
- Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Frederic Thony
- Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Gilbert Ferretti
- University of Grenoble Alpes, Grenoble, France; Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Ghelfi
- University of Grenoble Alpes, Grenoble, France; Department of Radiology, Grenoble Alpes University Hospital, Grenoble, France; INSERM U1209/CNRS UMR 5309, Institute for Advanced Biosciences, University of Grenoble Alpes, Grenoble, France.
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Direct Percutaneous Embolization of Uterine Arteriovenous Malformations. J Vasc Interv Radiol 2022; 33:607-609. [DOI: 10.1016/j.jvir.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 01/03/2022] [Accepted: 02/01/2022] [Indexed: 11/18/2022] Open
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Lin CY, Huang LW, Tsai YL, Seow KM. Outcomes and complications of severe acute postpartum hemorrhage treated with or without transarterial embolization in a single tertiary referral center: A 20-year experience. Taiwan J Obstet Gynecol 2021; 60:995-998. [PMID: 34794762 DOI: 10.1016/j.tjog.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE PPH is usually unpredictable; and such fast, urgent and sudden massive life-threating hemorrhage. This study is to assess the efficacy of transarterial embolization (TAE) in treating severe PPH in a single institution over a period of 20 years. MATERIALS AND METHODS From January 2000 to October 2019, all women with acute PPH more than 1500 cc and/or DIC were enrolled in this retrospective study. These women were divided into two groups according to whether they have received TAE as the second-line treatment. Group 1 (n = 27) included women without receiving TAE from January 1, 2000 to October 31, 2009, and group 2 (n = 30) included those who receiving TAE from November 1, 2009 to October 31, 2019. RESULTS The overall success rate of TAE in control the PPH and preserved the uterus is 80%. The hemoglobin 12 h after PPH in group 2 is significantly lower than in group 1 (7.64 ± 1.6 vs. 8.58 ± 1.9, respectively. P = 0.05). Total unit of packed red blood cell (pRBC) transfusion is significantly higher in the group 2 than group 1 (9.8 ± 5.7 vs. 6.8 ± 3.9; p = 0.03). The rate of hysterectomy is significantly higher in group 1 than group 2 (46.7 vs. 20%; p < 0.001). CONCLUSION In conclusion, TAE is safe and effective in control bleeding in PPH with a high success rate to preserve uterus and prevent DIC. TAE should be routinely used as a secondary line of treatment during PPH in all hospitals.
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Affiliation(s)
- Chin-Yi Lin
- Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Lee-Wen Huang
- Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Yieh-Loong Tsai
- Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Kok-Min Seow
- Department of Obstetrics and Gynecology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Zhang F, Xu M, Su X, Yuan W, Feng W, Su Q, Li F. Afterglow Implant for Arterial Embolization and Intraoperative Imaging. Chemistry 2021; 28:e202103795. [PMID: 34791739 DOI: 10.1002/chem.202103795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Indexed: 11/06/2022]
Abstract
Transcatheter arterial embolization (TAE) is wildly used in clinical treatments. However, the online monitoring of the thrombosis formation is limited due to the challenges of the direct visualization of embolic agents and the real-time monitoring of dynamic blood flow. Thus, we developed a photochemical afterglow implant with strong afterglow intensity and a long lifetime for embolization and imaging. The liquid pre-implant injected into the abdominal aorta of mice was rapidly transformed into a hydrogel in situ to embolize the blood vessel. The vascular embolism position can be observed by the enhanced afterglow of the fixed implant, and the long lifetime of afterglow can also be used to monitor the effect of embolization. This provides an excellent candidate in bio-imaging to avoid the autofluorescence interference from continuous light excitation. The study suggests the potential usefulness of the implant as an embolic agent in TAE and artery imaging during a surgical procedure.
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Affiliation(s)
- Fuying Zhang
- Department of Chemistry & State Key Laboratory of Molecular Engineering of Polymers & Institute of Biomedicine Science, Fudan University, Shanghai, 200433, P. R. China
| | - Ming Xu
- Department of Chemistry & State Key Laboratory of Molecular Engineering of Polymers & Institute of Biomedicine Science, Fudan University, Shanghai, 200433, P. R. China
| | - Xianlong Su
- Department of Chemistry & State Key Laboratory of Molecular Engineering of Polymers & Institute of Biomedicine Science, Fudan University, Shanghai, 200433, P. R. China
| | - Wei Yuan
- Department of Chemistry & State Key Laboratory of Molecular Engineering of Polymers & Institute of Biomedicine Science, Fudan University, Shanghai, 200433, P. R. China
| | - Wei Feng
- Department of Chemistry & State Key Laboratory of Molecular Engineering of Polymers & Institute of Biomedicine Science, Fudan University, Shanghai, 200433, P. R. China
| | - Qianqian Su
- Department of Chemistry & State Key Laboratory of Molecular Engineering of Polymers & Institute of Biomedicine Science, Fudan University, Shanghai, 200433, P. R. China.,Institute of Nanochemistry and Nanobiology, Shanghai University, Shanghai, 200444, P. R. China
| | - Fuyou Li
- Department of Chemistry & State Key Laboratory of Molecular Engineering of Polymers & Institute of Biomedicine Science, Fudan University, Shanghai, 200433, P. R. China
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Zwimpfer TA, Monod C, Redling K, Willi H, Takes M, Fellmann-Fischer B, Manegold-Brauer G, Hösli I. Uterine pseudoaneurysm on the basis of deep infiltrating endometriosis during pregnancy-a case report. BMC Pregnancy Childbirth 2021; 21:282. [PMID: 33836672 PMCID: PMC8034083 DOI: 10.1186/s12884-021-03753-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background Pseudoaneurysm of the uterine artery (UPA) is a rare cause of potentially life-threatening hemorrhage during pregnancy and puerperium. It is an uncommon condition that mainly occurs after traumatic injury to a vessel following pelvic surgical intervention, but also has been reported based on underlying endometriosis. There is an increased risk of developing UPA during pregnancy. Diagnosis includes clinical symptoms, with severe abdominal pain and is confirmed by sonographic or magnetic resonance imaging (MRI). Due to its potential risk of rupture, with a subsequent hypovolemic maternal shock and high fetal mortality, an interdisciplinary treatment should be considered expeditiously. Case presentation We present the case of a 34-year old pregnant symptomatic patient, where a large UPA was detected at 26 weeks, based on deep infiltrating endometriosis (DIE). The UPA was successfully treated by selective arterial embolization. After embolization, the pain decreased but the woman still required intravenous analgesics during follow-up. At 37 weeks she developed a sepsis from the intravenous catheter which led to a cesarean section and delivery of a healthy boy. She was discharged 10 days postpartum. Conclusions UPA should be considered in pregnant women with severe abdominal and pelvic pain, once other obstetrical factors have been excluded. DIE might be the underlying diagnosis. It is a rare but potentially life-threatening condition for mother and fetus.
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Affiliation(s)
- Tibor Andrea Zwimpfer
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland. .,Department of Biomedicine, University Hospital of Basel and University Basel, Basel, Switzerland.
| | - Cécile Monod
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland
| | - Katharina Redling
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland
| | - Heike Willi
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland
| | - Martin Takes
- Department of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
| | | | | | - Irene Hösli
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland
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Gupta A, Sagili H, Krishnan N, Dasari P. Pseudoaneurysm of uterine artery complicating caesarean section: a rare cause of intractable secondary postpartum haemorrhage managed with uterine artery embolisation. BMJ Case Rep 2021; 14:14/3/e239851. [PMID: 33753382 PMCID: PMC7986651 DOI: 10.1136/bcr-2020-239851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 27-year-old woman presented 6 weeks after an uncomplicated lower segment caesarean section with excessive bleeding per vagina. On examination, she had mild pallor with a pulse rate of 86 beats per minute and blood pressure of 116/80 mm Hg, uterus well involuted with closed cervical os and bleeding demonstrated through the cervix. A transvaginal ultrasonography with colour Doppler revealed a normal size uterus with an empty cavity and a hypoechoic area with blood flow within it in the left side of the uterus with a prominent arterial feeder vessel. A CT angiogram confirmed the diagnosis of a 1.3×0.7 cm pseudoaneurysm of the uterine artery near the left cornua of the uterus. After failed attempts to control the bleeding with antifibrinolytics, bilateral uterine arteries were embolised using gel foam. Post procedure, bleeding resolved immediately. A follow-up transvaginal ultrasound after a year revealed no evidence of the pseudoaneurysm and her fertility was preserved.
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Affiliation(s)
- Aishvarya Gupta
- Obstetrics and Gynecology, Indraprastha Apollo Hospital, New Delhi, India
- Obstetrics and Gynaecology, JIPMER, Puducherry, Pondicherry, India
| | - Haritha Sagili
- Obstetrics and Gynaecology, JIPMER, Puducherry, Pondicherry, India
| | | | - Papa Dasari
- Obstetrics and Gynaecology, JIPMER, Puducherry, Pondicherry, India
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Subrat P, Nalini S, Aisha KD, Anusmita S, Rituparna D, Pranjal P. Transcatheter Artery Embolization for Postoperative Haemorrhage after Arterio-Venous Malformation - Safer Option. Acta Med Litu 2021; 28:159-164. [PMID: 34393639 PMCID: PMC8311843 DOI: 10.15388/amed.2021.28.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/22/2022] Open
Abstract
Summary. Introduction: Hemorrhage is one of the commonest and dreaded complications especially with pelvic surgeries. Gestational trophoblastic neoplasias (GTN) are notorious for their propensity to bleed torrentially and metastasis to vital organs. GTN is associated with an arterio-venous malformation (AVM) about 10-15% of the time, which can lead to bleeding after surgery or after complete remission. After the failure of conventional management with chemotherapy or surgery one is compelled to take another modality of management. One of such methods is the use of transcatheter artery embolization in cases of GTN or post-hysterectomy cases of GTN. Transcatheter arteryembolization (TAE) was effective in controlling bleeding due to arterio-venous malformation in 96% of cases. Case: 46 years P2L2A5 (para 2, living issue 2, abortion 5) post-hysterectomy patient presented with bleeding from the vagina after surgery. Twice she underwent vaginal vault repair after hysterectomy but failed. Ultrasonography (USG) showed arterio-venous malformation (AVM); angiography revealed massive extravasation from (left internal iliac artery and abnormal vascularity from the right internal iliac. She was taken up for bilateral internal iliac arteries embolization but again had a heavy bout of bleeding after one week. CT scan confirmed a residual lesion and she underwent a repeat embolization after which the bleeding stopped. Serum BHCG was advised during workup and it was 1997 IU/ml. A diagnosis of GTN was confirmed. The patient was discharged after two cycles of chemotherapy with advice to review for the third one on an outpatient department basis. Conclusion: We concluded that TAE is an effective and safer alternative to surgery in postoperative bleeding from AV malformation in the case of GTN. It can be repeated and should be made to more liberal use in emergency settings.
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Affiliation(s)
- Panda Subrat
- Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences Shillong, Meghalaya, India
| | - Sharma Nalini
- Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences Shillong, Meghalaya, India
| | - Khan Dina Aisha
- Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences Shillong, Meghalaya, India
| | - Saha Anusmita
- Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences Shillong, Meghalaya, India
| | - Das Rituparna
- Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences Shillong, Meghalaya, India
| | - Phukan Pranjal
- Department of Imaging and Interventional Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences Shillong, Meghalaya, India
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Gilbert A, Thubert T, Dochez V, Riteau AS, Ducloyer M, Ragot P, Frampas E, Douane F, David A. Angiographic findings and outcomes after embolization of patients with suspected postabortion uterine arteriovenous fistula. J Gynecol Obstet Hum Reprod 2020; 50:102033. [PMID: 33301980 DOI: 10.1016/j.jogoh.2020.102033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The purpose of this study is to assess the angiographic incidence of uterine arteriovenous fistula (UAVF) in women referred for a high ultrasonographic suspicion in a postabortion setting and to evaluate the safety, efficacy and impact on further fertility of uterine artery embolization (UAE) in this indication. MATERIALS AND METHODS A monocentric retrospective study of 31patients managed by uterine artery embolization for suspected UAVF after spontaneous or induced first trimester abortion. The diagnosis of UAVF was confirmed when an early venous drainage was identified on the angiogram. Technical success was defined as complete exclusion of the vascular lesion. Clinical success was defined as the absence of bleeding during the clinical follow-up and during the surgery in case of hysteroscopic resection. Information about further fertility was gathered by phone calls to the patients. RESULTS The mean age of the patients was 30.8 (±6.0) years. The diagnosis of UAVF was angiographically confirmed in 6 patients (19.4 %). Angiographic findings of retained product of conception (RPOC) with varying degrees of vascularity were observed in remaining patients. The technical success rate of UAE was 100 %, mostly through a proximal and bilateral embolization using a resorbable agent (27/31 patients, 87.1 %). The clinical success rate of UAE was 100 % in the group treated by a single UAE. We did not notice any bleeding during the surgery in the group of patients who needed a further hysteroscopic resection. 14 patients led at least one subsequent pregnancy to term without any difficulty. CONCLUSION UAVF is a rare condition. We supposed it may constitute the ultimate stage in the natural history of the retained products of conception with "marked vascularity". UAE seems to be an effective and safe first-line treatment.
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Affiliation(s)
- Alizé Gilbert
- Department of Radiology, Nantes University Hospital, 9 Quai Moncousu, 44093, Nantes, France
| | - Thibault Thubert
- Department of Obstetrics and Gynecology, Nantes University Hospital, 38 Boulevard Jean Monnet, 44000, Nantes, France
| | - Vincent Dochez
- Department of Obstetrics and Gynecology, Nantes University Hospital, 38 Boulevard Jean Monnet, 44000, Nantes, France
| | - Anne-Sophie Riteau
- Department of Obstetrics and Gynecology, Jules Verne Medical Center, 2 - 4 Route de Paris, 44300, Nantes, France
| | - Mathilde Ducloyer
- Department of Radiology, Nantes University Hospital, 9 Quai Moncousu, 44093, Nantes, France
| | - Paul Ragot
- Department of Obstetrics and Gynecology, Nantes University Hospital, 38 Boulevard Jean Monnet, 44000, Nantes, France
| | - Eric Frampas
- Department of Radiology, Nantes University Hospital, 9 Quai Moncousu, 44093, Nantes, France
| | - Frédéric Douane
- Department of Radiology, Nantes University Hospital, 9 Quai Moncousu, 44093, Nantes, France
| | - Arthur David
- Department of Radiology, Nantes University Hospital, 9 Quai Moncousu, 44093, Nantes, France.
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Cojocaru L, Lankford A, Galey J, Bharadwaj S, Kodali BS, Kennedy K, Goetzinger K, Turan OM. Surgical advances in the management of placenta accreta spectrum: establishing new expectations for operative blood loss. J Matern Fetal Neonatal Med 2020; 35:4496-4505. [PMID: 33272057 DOI: 10.1080/14767058.2020.1852213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate whether the implementation of our surgical approach, referred to in the text as Linear Cutter Vessel Sealing System (LCVSS) technique, will improve perioperative outcomes in patients with placenta accreta spectrum (PAS), specifically by reducing blood loss and blood transfusion rates at the time of cesarean hysterectomy (C-HYST). The LCVSS technique integrates the following: (1) hysterotomy performed using the Linear Cutter, (2) no placental manipulation, (3) cauterization of anatomically prominent vascular anastomosis using the handheld vessel sealing system, and (4) completion of bladder dissection until the cervico-vaginal junction before ligation and division of uterine arteries. MATERIALS AND METHODS This is a retrospective cohort study that analyzed perioperative outcomes in patients undergoing C-HYST for PAS at a tertiary care center from 1 July 2014 to 1 December 2019. Comparisons were performed between cases managed with the use of the LCVSS technique (designated as LCVSS cohort) and those managed without the use of the LCVSS technique (designated as no technique cohort). The primary outcomes were cumulative blood loss (CBL) and total perioperative blood transfusion of ≥4 and ≥6 units of PRBCs. The secondary outcomes were intra- and postoperative complications. Continuous and categorical variables were compared according to the sample size and distribution. Binary logistic regression analysis was performed to predict confounders for blood transfusion of ≥4 units of PRBCs. RESULTS A total of 69 prenatally diagnosed PAS cases underwent C-HYST at the time of delivery. Forty-four cases that were performed using the LCVSS technique comprised the LCVSS cohort. The remaining 25 were marked as no technique cohort. CBL was significantly lower in the LCVSS cohort (1124 ml [300-4100] vs 3500 ml [650-10600]; p < .001). The rate of urinary tract injuries was similar (16%). The rate of postoperative complications and reoperation for intra-abdominal bleeding were lower but not significantly different in LCVSS cohort (9 vs 20% and 0 vs 8%, p = .26 and p = .12, respectively). There were no differences in neonatal outcomes. CONCLUSION Implementation of this advanced surgical approach for PAS management resulted in reduced blood loss and blood transfusion rates in comparison with no technique cohort.
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Affiliation(s)
- Liviu Cojocaru
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Allison Lankford
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jessica Galey
- Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shobana Bharadwaj
- Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bhavani S Kodali
- Division of Obstetric Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kelly Kennedy
- Department of Obstetrics, Gynecology and Reproductive Science, Center for Advanced Fetal Care, University of Maryland Medical Center, Baltimore, MD, USA
| | - Katherine Goetzinger
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ozhan M Turan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA
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Preoperative Prophylactic Balloon-Assisted Occlusion of the Internal Iliac Arteries in the Management of Placenta Increta/Percreta. ACTA ACUST UNITED AC 2020; 56:medicina56080368. [PMID: 32717928 PMCID: PMC7466236 DOI: 10.3390/medicina56080368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/22/2020] [Indexed: 11/18/2022]
Abstract
Background and Objectives: Preoperative prophylactic balloon-assisted occlusion (PBAO) of the internal iliac arteries minimizes blood loss and facilitates surgery performance, through reductions in the rate of uterine perfusion, which allow for better control in hysterectomy performance, with decreased rates of bleeding and surgical complications. We aimed to investigate the maternal and fetal outcomes associated with PBAO use in women with placenta increta or percreta. Material and Methods: The records of 42 consecutive patients with a diagnosis of placenta increta or percreta were retrospectively reviewed. Of 42 patients, 17 patients (40.5%) with placenta increta or percreta underwent cesarean delivery after prophylactic balloon catheter placement in the bilateral internal iliac artery (balloon group). The blood loss volume, transfusion volume, postoperative hemoglobin changes, rates of hysterectomy and hospitalization, and infant Apgar score in this group were compared to those of 25 similar women who underwent cesarean delivery without balloon placement (surgical group). Results: The mean intraoperative blood loss volume in the balloon group (2319 ± 1191 mL, range 1000–4500 mL) was significantly lower than that in the surgical group (4435 ± 1376 mL, range 1500–10,500 mL) (p = 0.037). The mean blood unit volume transfused in the balloon group (2060 ± 1154 mL, range 1200–8000 mL) was significantly lower than that in the surgical group (3840 ± 1464 mL, range 1800–15,200 mL) (p = 0.043). There was no significant difference in the postoperative hemoglobin change, hysterectomy rates, length of hospitalization, or infant Apgar score between the groups. Conclusion: PBAO of the internal iliac artery prior to cesarean delivery in patients with placenta increta or percreta is a safe and minimally invasive technique that reduces the rate of intraoperative blood loss and transfusion requirements.
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Chiang HW, Chiang HJ, Li JH, Tsang LLC. Evaluation of scattered radiation dose received by medical staff during uterine artery embolization in the operating room. Technol Health Care 2020; 28:3-11. [PMID: 32364139 PMCID: PMC7369110 DOI: 10.3233/thc-209002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND: The air kerma radiation doses have gained much attention since the operating room interventional radiology is a place where medical staff are exposed to a fluoroscopy environment and gain a cumulative dose during the uterine artery embolization procedure. OBJECTIVE: We aimed to evaluate the radiation dose received by medical staff by applying a flat X-ray machine in the surgical room during uterine artery embolization. METHODS: An ATOM humanoid model was laid on the operating table and simulated a patient. The scattered radiation dose received by the radiologist, anesthetist and radiologic technologist was evaluated. The scintillation detector was adopted. The measurement points were 50 cm, 100 cm and 150 cm above the floor, representing the limbs, abdomen and thyroid level, respectively. We compared the X-rays under different tube voltages of 70, 80, and 90, respectively and frames per second (FPS) of 30, 15, and 7.5, respectively. We configured the dose level per pulse of 40 nGy with a fixed detector. RESULTS: In Section 1, when the tube voltage was 70 kVp and 7.5 FPS, the average radiation doses of limbs, abdomen and thyroid level was 0.48, 1.3 and 1.9 μSv/min respectively. When the tube voltage was 80 kVp and the fluoroscopy decreases from 30 FPS to 7.5 FPS, 58% of the radiation dose was reduced. When the tube voltage was 90 kVp, the radiation dose in the lead garment increased 31–177% in comparison to when the tube voltage was 80 kVp. Sections 2 and 3 were far away from the central ray, so the highest radiation dose 100 cm above the floor were 0.05 and 0.02 μSv/min. CONCLUSIONS: Lead garment can effectively reduce medical staff from occupational doses with an average attenuation rate of 90%. 80 kVp was most commonly used. Fluoroscopy 7.5 FPS was used 100 cm above the floor in A section and the lowest radiation dose was 1.33 μSv/min. The operator should decrease the duration of X-rays or adopt suspended lead shielding to decrease the radiation dose received by the operator. When kVp increases, the penetration increases. Decreasing FPS cannot decrease occupational doses of medical staff.
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Affiliation(s)
| | | | | | - Leo Leung-Chit Tsang
- Corresponding author: Leo Leung-Chit Tsang, Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. E-mails: or hsienwen30 @gmail.com
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Merriam AA, Huang Y, Wright JD, Goffman D, D'Alton ME, Friedman AM. Use of Uterine Tamponade and Interventional Radiology Procedures During Delivery Hospitalizations. Obstet Gynecol 2020; 135:674-684. [PMID: 32028498 PMCID: PMC7040521 DOI: 10.1097/aog.0000000000003722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize use of uterine tamponade and interventional radiology procedures. METHODS This retrospective study analyzed uterine tamponade and interventional radiology procedures in a large administrative database. The primary outcomes were temporal trends in these procedures 1) during deliveries, 2) by hospital volume, and 3) before hysterectomy for uterine atony or delayed postpartum hemorrhage. Three 3-year periods were analyzed: 2006-2008, 2009-2011, and 2012-2014. Risk of morbidity in the setting of hysterectomy with uterine tamponade and interventional radiology procedures as the primary exposures was additionally analyzed in adjusted models. RESULTS The study included 5,383,486 deliveries, which involved 6,675 uterine tamponade procedures, 1,199 interventional radiology procedures, and 1,937 hysterectomies. Interventional radiology procedures increased from 16.4 to 25.7 per 100,000 delivery hospitalizations from 2006-2008 to 2012-2014 (P<.01), and uterine tamponade increased from 86.3 to 158.1 (P<.01). Interventional radiology procedures use was highest (45.0/100,000 deliveries, 95% CI 41.0-48.9) in the highest and lowest (8.9/100,000, 95% CI 7.1-10.7) in the lowest volume quintile. Uterine tamponade procedures were most common in the fourth (209.8/100,000, 95% CI 201.1-218.5) and lowest in the third quintile (59.8/100,000, 95% CI 55.1-64.4). Interventional radiology procedures occurred before 3.3% of hysterectomies from 2006 to 2008 compared with 6.3% from 2012 to 2014 (P<.05), and uterine tamponade procedures increased from 3.6% to 20.1% (P<.01). Adjusted risks for morbidity in the setting of uterine tamponade and interventional radiology before hysterectomy were significantly higher (adjusted risk ratio [aRR] 1.63, 95% CI 1.47-1.81 and aRR 1.75 95% CI 1.51-2.03, respectively) compared with when these procedures were not performed. CONCLUSION This analysis found that uterine tamponade and interventional radiology procedures became increasingly common over the study period, are used across obstetric volume settings, and in the setting of hysterectomy may be associated with increased risk of morbidity, although this relationship is not necessarily causal.
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Affiliation(s)
- Audrey A Merriam
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, Connecticut; and the Department of Obstetrics and Gynecology, Columbia University, New York, New York
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Liu Z, Wang Y, Yan J, Li J, Liu X, Zhang L, Cheng L. Uterine artery embolization versus hysterectomy in the treatment of refractory postpartum hemorrhage: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2020; 33:693-705. [PMID: 30354858 DOI: 10.1080/14767058.2018.1497599] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 06/16/2018] [Accepted: 07/03/2018] [Indexed: 01/11/2023]
Abstract
Introduction: We carried out a systematic review and meta-analysis to assess the safety and effectiveness of uterine artery embolization (UAE) compared with conventional hysterectomy on refractory postpartum hemorrhage (PPH).Methods: We searched PubMed, Embase, Chinese National Knowledge Infrastructure database (CNKI), Cochrane Library, and Wanfang database through October 2017 for randomized controlled trials (RCTs) and observational studies assessing the safety and effectiveness of UAE compared with hysterectomy on refractory PPH. The main outcome measures included the blood loss, operating time, hemostatic effective rate, and length of stay.Results: Six RCTs and nine observational studies were included in the meta-analysis, which involved 1142 women with refractory PPH. The results demonstrated that UAE was more beneficial on refractory PPH compared with hysterectomy using four scales: blood loss (WMD 893.39 mL; 95% CI: -1205.65, -581.13; p < .001); operating time (WMD -37.19 minutes; 95% CI: -44.42, -29.96; p < .001); length of stay (WMD -5.36 days; 95% CI: -5.76, -4.97; p < .001), hemostatic effective rate (OR 1.58, 95% CI: 0.80, 3.12, p = .184) .Conclusions: In the present meta-analysis, the positive findings suggest UAE has beneficial effects on refractory PPH. UAE significantly reduced blood loss, shortened the operating time, and length of stay compared with hysterectomy. And there is no difference between the UAE group and hysterectomy group in hemostatic effective rate. However, those findings should be treated with caution because of heterogeneity and potential biases.
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Affiliation(s)
- ZhiRong Liu
- Department of General Surgery, Second People's Hospital of Chengdu, Chengdu, China
| | - Yaxuan Wang
- Department of Medical Imaging, Chengdu Medical College, Chengdu, China
| | - Jingxin Yan
- Department of Medical Imaging, Chengdu Medical College, Chengdu, China
| | - Juan Li
- Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China
| | - XinLian Liu
- Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China
| | - LuShun Zhang
- Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, China
- Development and Regeneration Key Laboratory of Sichuan Province, Collaborative Innovation Center of Sichuan for Elderly Care and Health, Chengdu Medical College, Chengdu, China
| | - Li Cheng
- School of Basic Medical Sciences, Chengdu Medical College, Chengdu, China
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Camacho A, Ahn EH, Appel E, Boos J, Nguyen Q, Justaniah AI, Faintuch S, Ahmed M, Brook OR. Uterine Artery Embolization with Gelfoam for Acquired Symptomatic Uterine Arteriovenous Shunting. J Vasc Interv Radiol 2019; 30:1750-1758. [DOI: 10.1016/j.jvir.2019.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 01/10/2023] Open
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Meyer-Wilmes P, Powerski M, Fischbach F, Omari J, Damm R, Pech M. Transarterial embolisation for the treatment of acute gynecological cancer bleeding. Arch Gynecol Obstet 2019; 300:1391-1397. [PMID: 31576453 DOI: 10.1007/s00404-019-05316-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 09/21/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Acute bleeding in patients with gynecological cancer may result in serious life-threatening complications. In these situations, immediate diagnostic and appropriate treatment is a challenge for attending physicians. Accordingly, transarterial embolisation (TAE) has been described as an increasing and effective treatment alternative to surgery and radiotherapy. METHODS In the present retrospective study, 25 patients were included who underwent a TAE in the period from January 2006 to June 2013 due to acute gynecological cancer bleeding. The objective of this study was to assess the efficiency and outcome of TAE. RESULTS The primary technical success rate was 92.0% (n = 23). 21 patients were analyzed in the 30-day follow-up. The clinical success rate was achieved in 90.5% (n = 19). A clinical failure due to rebleeding was observed in 9.5% (n = 2). No associations were revealed between rebleeding and technical/clinical factors. Within 30 days after the last TAE, the complication and mortality rates were 0.0% and 5.0% (n = 1), respectively. CONCLUSION TAE was found as an effective and safe treatment in the clinical setting of acute gynecological cancer bleeding. An important component of efficient management is an early and interdisciplinary care. Optimal treatment can be achieved by close cooperation between gynecologists, radiotherapists and interventional radiologists.
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Affiliation(s)
- Philipp Meyer-Wilmes
- Department of Gynecology and Obstetrics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Frank Fischbach
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Jazan Omari
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Robert Damm
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
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Selçuk İ, Uzuner B, Boduç E, Baykuş Y, Akar B, Güngör T. Step-by-step ligation of the internal iliac artery. J Turk Ger Gynecol Assoc 2019; 20:123-128. [PMID: 30499283 PMCID: PMC6558362 DOI: 10.4274/jtgga.galenos.2018.2018.0124] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The internal iliac artery is the main vascular supply of pelvic visceral structures. All pelvic surgeons must know the anatomic landmarks and basic steps of internal iliac artery ligation in order to stop massive pelvic hemorrhage. This cadaveric demonstration and clinical review of the internal iliac artery shows the anatomic landmarks and basic steps of internal iliac artery ligation.
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Affiliation(s)
- İlker Selçuk
- Clinic of Gynecologic Oncology, Health Sciences University, Zekai Tahir Burak Woman’s Health Training and Research Hospital, Ankara, Turkey
| | - Bora Uzuner
- Department of Anatomy, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Erengül Boduç
- Department of Anatomy, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Yakup Baykuş
- Department of Obstetrics and Gynecology, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Bertan Akar
- Clinic of Obstetrics and Gynecology, VM Medical Park Kocaeli Hospital, Kocaeli, Turkey
| | - Tayfun Güngör
- Clinic of Gynecologic Oncology, Health Sciences University, Zekai Tahir Burak Woman’s Health Training and Research Hospital, Ankara, Turkey
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DiGiacinto D, Bagley JE, Gildon B, Cantrell G. Postpartum Pseudoaneurysm After Cesarean Delivery. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479318816985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Uterine artery pseudoaneurysm is an uncommon vascular lesion that can be life threatening. A ruptured uterine artery pseudoaneurysm can cause acute massive hemorrhaging, creating a true emergency for the postpartum patient. The etiology is more commonly seen with traumatic procedures such as cesarean delivery or curettage. This case report is of a patient with a history of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome who presented with heavy bleeding after a cesarean delivery. Sonography was primarily used to diagnose the uterine artery pseudoaneurysm. Because of the massive hemorrhaging in this case, a hysterectomy was performed.
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Affiliation(s)
- Dora DiGiacinto
- University of Oklahoma Health Sciences Center, Medical Imaging and Radiation Sciences, Oklahoma City, OK, USA
| | - Jennifer E. Bagley
- University of Oklahoma Health Sciences Center, Medical Imaging and Radiation Sciences, Oklahoma City, OK, USA
| | - Bradford Gildon
- University of Oklahoma Health Sciences Center, Medical Imaging and Radiation Sciences, Oklahoma City, OK, USA
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Wang CY, Pan HH, Chang CC, Lin CK. Outcomes of hypogastric artery ligation and transcatheter uterine artery embolization in women with postpartum hemorrhage. Taiwan J Obstet Gynecol 2019; 58:72-76. [DOI: 10.1016/j.tjog.2018.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2018] [Indexed: 10/27/2022] Open
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Leduc D, Senikas V, Lalonde AB. No. 235-Active Management of the Third Stage of Labour: Prevention and Treatment of Postpartum Hemorrhage. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e841-e855. [DOI: 10.1016/j.jogc.2018.09.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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No 235 - Prise en charge active du troisième stade du travail: Prévention et prise en charge de l'hémorragie postpartum. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e856-e873. [DOI: 10.1016/j.jogc.2018.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Huang KL, Tsai CC, Fu HC, Cheng HH, Lai YJ, Hung HN, Tsang LLC, Hsu TY. Prophylactic Transcatheter Arterial Embolization Helps Intraoperative Hemorrhagic Control for REMOVING Invasive Placenta. J Clin Med 2018; 7:jcm7110460. [PMID: 30469429 PMCID: PMC6262565 DOI: 10.3390/jcm7110460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives: The purpose of this article is to investigate the estimated blood loss in pregnant women undergoing cesarean section and placental extirpation to treat abnormal placentation and compare the outcomes of those who underwent prophylactic transcatheter arterial embolization (TAE) with those who did not. Methods: A retrospective study was conducted on 17 pregnant women diagnosed with abnormal placentation in 2001–2018 in a single tertiary center. The patients were diagnosed by surgical finding, ultrasound, or magnetic resonance imaging (MRI). These patients were divided into two groups: a prophylactic TAE group (11 patients) and a control group (6 patients). In the former group, prophylactic TAE of the bilateral uterine artery (UA) and/or internal iliac artery (IIA) was performed immediately after delivery of the infant. The placenta was removed in both groups. The primary outcomes were estimated blood loss (EBL), units of packed red blood cell (pRBC) transfusion, operative time, whether hysterectomy was performed, whether the patient was transferred to the intensive care unit (ICU), and hospitalization days. The secondary outcome was maternal complications. Results: Patients who received prophylactic TAE had significantly reduced intraoperative blood loss (990.9 ± 701.7 mL vs. 3448.3 ± 1767.4 mL, p = 0.018). Units of pRBC transfusion, operative time, hysterectomy, transfer to the ICU, and postoperative hospitalization days were not significantly different between the two groups. Thirteen patients (9 in the TAE group and 4 in the control group) received a blood transfusion during the operation. Three patients underwent a hysterectomy (1 in the TAE group and 2 in the control group). Five patients were transferred to the ICU (3 in the TAE group and 2 in the control group) for maternal complications or monitoring. In the prophylactic TAE group, 3 patients (27%) had a subsequent pregnancy within the next 5 years. Conclusions: Prophylactic TAE was safe and effective for reducing intraoperative hemorrhage from removing an invasive placenta in patients with abnormal placentation.
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Affiliation(s)
- Kun-Long Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospitaland Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Ching-Chang Tsai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospitaland Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Hung-Chun Fu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospitaland Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Hsin-Hsin Cheng
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospitaland Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Yun-Ju Lai
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospitaland Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Hsuan-Ning Hung
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospitaland Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Leo Leung-Chit Tsang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Te-Yao Hsu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospitaland Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
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MRA Mapping and Selective Embolization of a Large Uterine Cavity Pseudoaneurysm at 20 Weeks of Gestation. Case Rep Obstet Gynecol 2018; 2018:3610492. [PMID: 29854511 PMCID: PMC5964500 DOI: 10.1155/2018/3610492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/26/2018] [Indexed: 11/18/2022] Open
Abstract
Antepartum uterine cavity pseudoaneurysm rupture can cause massive hemorrhage with high maternal and fetal mortality risk. Invasive placentation can predispose to vascular malformations. We present a novel use of macrocyclic intravenous contrast-enhanced magnetic resonance angiography for preprocedure planning followed by selective low radiation embolization of a uterine cavity pseudoaneurysm in the setting of invasive placentation at 20 weeks of gestation. To our knowledge, this is the first reported case of uterine cavity pseudoaneurysm successfully mapped with MRA and treated with embolization at 20 weeks of gestation.
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Subramaniam S, Nadarajan C, Aziz ME. Role of Uterine Artery Embolization in Pseudoaneurysm of Uterine Artery: A Rare Cause of Secondary Postpartum Hemorrhage. Cureus 2018; 10:e2220. [PMID: 29692958 PMCID: PMC5912705 DOI: 10.7759/cureus.2220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Uterine artery pseudoaneurysm is an uncommon cause of secondary postpartum hemorrhage, although it carries a high mortality rate. The etiology includes vascular trauma during cesarean section, vaginal delivery, curettage or hysterotomy. We present a post-cesarean female who developed delayed hemorrhage and was diagnosed with left uterine artery pseudoaneurysm. Selective transcatheter arterial embolization was performed and the pseudoaneurysm was successfully obliterated. Angiographic embolization is a safe and efficient method of treatment of postpartum hemorrhage due to pseudoaneurysm in hemodynamically stable patients. Thus, it should be considered as a treatment option before opting for surgery in favorable cases.
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Affiliation(s)
- Saraswathy Subramaniam
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia
| | - Chandran Nadarajan
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia
| | - Mohd E Aziz
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia
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29
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Alturki F, Ponette V, Boucher LM. Spontaneous Retroperitoneal Hematomas Following Uncomplicated Vaginal Deliveries: A Case Report and Literature Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:712-715. [PMID: 29274933 DOI: 10.1016/j.jogc.2017.08.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Retroperitoneal hematomas are rare in obstetrics. CASE PRESENTATION A 36-year-old female presented two days following uncomplicated non-traumatic spontaneous vaginal delivery with an acute onset of severe left lower quadrant abdominal pain. The patient was hypotensive, tachycardic, and febrile. The hemoglobin dropped post delivery to 75 g/L. A non-contrast CT scan revealed a retroperitoneal hematoma. MANAGEMENT AND OUTCOME Conservative management approaches resulted in spontaneous remission of the retroperitoneal hematoma.
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Affiliation(s)
- Faisal Alturki
- Department of Obstetrics and Gynecology, McGill University, Montréal, QC.
| | - Vincent Ponette
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montréal, QC
| | - Louis-Martin Boucher
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montréal, QC
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30
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Spreu A, Abgottspon F, Baumann MU, Kettenbach J, Surbek D. Efficacy of pelvic artery embolisation for severe postpartum hemorrhage. Arch Gynecol Obstet 2017; 296:1117-1124. [PMID: 28993867 DOI: 10.1007/s00404-017-4554-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 09/22/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of our study was to evaluate the outcome of selective pelvic arterial embolisation (PAE) in women with severe postpartum hemorrhage (PPH). METHODS We performed a retrospective, controlled, single-center cohort study. A total of 16 consecutive women with PPH who underwent therapeutic PAE were included. As historical control group, we included 22 women with similar severity of PPH who were managed without PAE. Outcome measures included necessity of surgical interventions such as postpartum hysterectomy and laparotomy after vaginal delivery, the amount of red blood cell transfusions, and hematologic findings after the procedure. RESULTS PAE was successful in stopping PPH and preserving the uterus in all 16 women in the study group. No woman in the PAE group required a postpartum hysterectomy, whereas postpartum hysterectomy was unavoidable in two women in the control group. Laparotomy after vaginal delivery was necessary in two women of the group without embolisation. Hematologic parameters after the treatment were better in the PAE group than in the control group, although these differences were only in part statistically significant. There were no unwarranted effects of PAE identifiable in the study group. CONCLUSION This is the first controlled study assessing the efficacy of PAE for the treatment of PPH. Our data suggest that PAE is effective for the treatment of severe PPH. In view of the lack of complications and unwarranted effects, clinical use of PAE in severe PPH seems justified, particularly in view of the life-threatening condition and the potential to preserve fertility in affected patients. Further evidence from well-designed prospective randomized-controlled trials would be nevertheless desirable in the future.
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Affiliation(s)
- Annette Spreu
- Department of Obstetrics and Gynecology, Inselspital University Hospital, University of Bern, Effingerstrasse 102, 3010, Bern, Switzerland.
| | - F Abgottspon
- Department of Obstetrics and Gynecology, Inselspital University Hospital, University of Bern, Effingerstrasse 102, 3010, Bern, Switzerland
| | - M U Baumann
- Department of Obstetrics and Gynecology, Inselspital University Hospital, University of Bern, Effingerstrasse 102, 3010, Bern, Switzerland
| | - J Kettenbach
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - D Surbek
- Department of Obstetrics and Gynecology, Inselspital University Hospital, University of Bern, Effingerstrasse 102, 3010, Bern, Switzerland
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Das CJ, Rathinam D, Manchanda S, Srivastava DN. Endovascular uterine artery interventions. Indian J Radiol Imaging 2017; 27:488-495. [PMID: 29379246 PMCID: PMC5761178 DOI: 10.4103/ijri.ijri_204_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Percutaneous vascular embolization plays an important role in the management of various gynecologic and obstetric abnormalities. Transcatheter embolization is a minimally invasive alternative procedure to surgery with reduced morbidity and mortality, and preserves the patient's future fertility potential. The clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as fibroid, adenomyosis, and arteriovenous malformations (AVMs), as well as intractable bleeding due to inoperable advanced-stage malignancies. The most well-known and well-studied indication is uterine fibroid embolization. Uterine artery embolization (UAE) may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage (PPH), placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury. This article discusses these gynecologic and obstetric indications for transcatheter embolization and reviews procedural techniques and outcomes.
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Affiliation(s)
- Chandan J Das
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Rathinam
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - D N Srivastava
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
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Tanaka K, Muraoka Y, Toda Y, Kiyomoto C, Okubo Y, Nagashima T, Furukawa S, Fujiwara M, Mochizuki M, Kobayashi Y, Iwashita M. Finegoldia magna myometritis with uterine necrosis after uterine artery embolisation. J OBSTET GYNAECOL 2017; 37:688-689. [PMID: 28319430 DOI: 10.1080/01443615.2017.1286303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kei Tanaka
- a Department of Obstetrics and Gynecology , Kyorin University School of Medicine , Tokyo , Japan
| | - Yuma Muraoka
- a Department of Obstetrics and Gynecology , Kyorin University School of Medicine , Tokyo , Japan
| | - Yumi Toda
- a Department of Obstetrics and Gynecology , Kyorin University School of Medicine , Tokyo , Japan
| | - Chikage Kiyomoto
- a Department of Obstetrics and Gynecology , Kyorin University School of Medicine , Tokyo , Japan
| | - Yasuhiro Okubo
- b Department of Pathology , Kyorin University School of Medicine , Tokyo , Japan
| | - Takashi Nagashima
- a Department of Obstetrics and Gynecology , Kyorin University School of Medicine , Tokyo , Japan
| | - Seishi Furukawa
- a Department of Obstetrics and Gynecology , Kyorin University School of Medicine , Tokyo , Japan
| | - Masachika Fujiwara
- b Department of Pathology , Kyorin University School of Medicine , Tokyo , Japan
| | - Makoto Mochizuki
- b Department of Pathology , Kyorin University School of Medicine , Tokyo , Japan
| | - Yoichi Kobayashi
- a Department of Obstetrics and Gynecology , Kyorin University School of Medicine , Tokyo , Japan
| | - Mitsutoshi Iwashita
- a Department of Obstetrics and Gynecology , Kyorin University School of Medicine , Tokyo , Japan
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33
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Parker R, Wuerdeman M, Grant M, Kitley C. Novel approach to uterine artery pseudoaneurysm embolization for delayed post-partum hemorrhage. J Obstet Gynaecol Res 2016; 42:1870-1873. [DOI: 10.1111/jog.13140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/27/2016] [Accepted: 07/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Ross Parker
- Department of Radiology; Madigan Army Medical Center; Tacoma Washington USA
| | - Marc Wuerdeman
- Department of Radiology; Madigan Army Medical Center; Tacoma Washington USA
| | - Matthew Grant
- Department of Radiology; Madigan Army Medical Center; Tacoma Washington USA
| | - Charles Kitley
- Department of Radiology; Madigan Army Medical Center; Tacoma Washington USA
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34
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Miller AD, Oner C, Kosik ES, McCalla S. Obstetric Hemorrhage Current Management and Usefulness of Protocols, Checklist, Drills. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0175-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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Kim CH, Jeon GS, Lee SJ, Kang SH. Embolization of the inferior mesenteric artery for post-partum hemorrhage with a vaginal laceration: A case with unusual collateral supply. J Obstet Gynaecol Res 2016; 42:1878-1880. [PMID: 27718301 DOI: 10.1111/jog.13147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/21/2016] [Accepted: 07/30/2016] [Indexed: 11/28/2022]
Abstract
A 36-year-old primipara woman was referred to the interventional department for management of severe primary post-partum hemorrhage with a vaginal laceration after a normal vaginal delivery. Angiography revealed that the superior rectal branch of the inferior mesenteric artery was one of the origins of persistent vaginal bleeding following embolization of both uterine arteries. The patient was successfully treated by selective embolization without other complications. Our case report highlights that the inferior mesenteric artery should be considered as an unusual extrauterine source for post-partum hemorrhage.
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Affiliation(s)
- Cho Hee Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Gyeong Sik Jeon
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Shin Jae Lee
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Suk Ho Kang
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
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36
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Kim CH, Lee SJ, Jeon GS, Kang SH, Kim HC. Embolization of Inferior Mesenteric Artery for Intractable Intrapelvic and Vaginal Bleeding After Hysterectomy. J Minim Invasive Gynecol 2016; 23:1191-1194. [PMID: 27449694 DOI: 10.1016/j.jmig.2016.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/01/2016] [Accepted: 07/03/2016] [Indexed: 11/17/2022]
Abstract
Branches of the internal iliac artery or ovarian artery are the typical sources of pelvic hemorrhage. The inferior mesenteric artery has been rarely reported as the origin of pelvic bleeding. We present 2 cases of intractable intrapelvic and vaginal bleeding after hysterectomy. One patient underwent a hysterectomy because of uncontrolled postpartum hemorrhage and another underwent a vaginal hysterectomy to treat vaginal prolapse. Both patients were subjected to angiography to control continuous vaginal bleeding after hysterectomy. The angiography revealed that the bleeding originated from the inferior mesenteric artery. Selective embolization of the inferior mesenteric artery successfully controlled the intractable intrapelvic and vaginal bleeding without complications. The inferior mesenteric artery is a potential source of intractable intrapelvic and vaginal bleeding for patients with a lower genital tract injury.
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Affiliation(s)
- Cho Hee Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Shin Jae Lee
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
| | - Gyeong Sik Jeon
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Suk Ho Kang
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hyeon Chul Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Abstract
Fibroid disease is common and causes significant health problems in women of childbearing age. Over the past several years, uterine artery embolization (UAE) has emerged as a minimally invasive treatment for symptomatic uterine myomata. Embolotherapy is effective in relieving myoma-related symptoms in 80% to 90% of patients. It requires shorter hospitalizations than traditional surgical therapies for myoma disease and is associated with faster recovery and lower complication risks than surgery. Patient selection, the UAE procedure, and post-UAE management are reviewed.
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38
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El-Agwany AS. Bilateral Absence of Common Iliac Artery: Abnormal anatomical variation of the Internal Iliac Artery During Ligation in Conservative Surgical Management of Placenta Previa Accreta. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0053-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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39
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Singh A, Kishore R, Saxena SS. Ligating Internal Iliac Artery: Success beyond Hesitation. J Obstet Gynaecol India 2016; 66:235-41. [PMID: 27651610 DOI: 10.1007/s13224-016-0859-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/09/2016] [Indexed: 10/22/2022] Open
Abstract
AIM To study the outcomes, benefits and complications of internal iliac artery ligation in both obstetric and gynecological cases. OBJECTIVE To study the outcomes, effectiveness and complications of internal iliac artery ligation (IIAL). METHOD This is an analytical longitudinal study done among women who have undergone internal iliac artery ligation in Dr. BRAMH a tertiary referral center from July 2013 to June 2015. Follow-up was done through color Doppler analysis of pelvic arteries before discharge, after 6 weeks and after 6 months. RESULT The efficacy of IIAL was 96.87 %. The mean shock index was 0.94 ± 0.26. Sixty-four women underwent IIAL out of which placenta previa (21.8 %) was the major indication. There were four maternal deaths. There were no intraoperative or ischemic complications. The greater the time interval between onset of hemorrhage and IIAL, the graver the outcome. For all women in whom uterus could be salvaged, resumption of menstrual cycles was seen within 6 months of IIAL. There was a significant decrease in the RI and PI of uterine arteries. In the ovarian arteries, there was a significant increase in RI and no significant change in PI initially. Flow in distal part of ligated internal iliac arteries could be detected in 54 (90 %) women out of 60 after 6 months of ligation of internal iliac arteries. CONCLUSION IIAL is an effective life-saving method to control obstetric and gynecological hemorrhage, and a hysterectomy can often be avoided. Early resort to IIAL is vital for improving the patient outcome. Uterine perfusion is well maintained, while there may be a decrease in ovarian perfusion. Resumption of menstrual cycles and presence of distal flow in internal iliac artery within 6 months suggest the preservation of future fertility; in order to better understand the impact of IIAL on ovarian functions and future fertility, larger studies with longer follow-up periods need to be conducted.
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Affiliation(s)
- Abha Singh
- Department of Obstetrics and Gynecology, Pt. J.N.M. Medical College, Raipur, India
| | - Ruchi Kishore
- Department of Obstetrics and Gynecology, Pt. J.N.M. Medical College, Raipur, India
| | - Saveri Sarbhai Saxena
- Department of Obstetrics and Gynecology, Pt. J.N.M. Medical College, Raipur, India ; Sarbhai Nursing Home, Mahadev Ghat Road, Daganiya, Raipur, CG India
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40
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Chacko J, Gross S, Swischuk PN, Hailu T, Hahn B. Young Woman With Vaginal Bleeding. Uterine artery pseudoaneurysm. Ann Emerg Med 2016; 67:e3-4. [PMID: 26801388 DOI: 10.1016/j.annemergmed.2015.07.493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Jerel Chacko
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, NY
| | - Stuart Gross
- Department of Obstetrics and Gynecology, Jackson North Medical Center, North Miami Beach, FL
| | - Peter N Swischuk
- Department of Radiology, Jackson North Medical Center, North Miami Beach, FL
| | - Theodoros Hailu
- Department of Emergency Medicine, Jackson North Medical Center, North Miami Beach, FL
| | - Barry Hahn
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, NY
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41
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Eskandari A, Mukherjee A, McHugh J. Transarterial embolization for management of severe postcoital bleeding. SAGE Open Med Case Rep 2016; 4:2050313X16662803. [PMID: 27551425 PMCID: PMC4976789 DOI: 10.1177/2050313x16662803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/27/2016] [Indexed: 11/17/2022] Open
Abstract
Objectives: Postcoital bleeding is an uncommon cause of gynecologic hemorrhage; however, it can be severe in a majority of cases necessitating surgical management. Methods: We report a case of severe postcoital bleeding in a young woman requiring blood transfusion. Results: Hemostasis was achieved using subselective embolization of cervical artery by metallic coils. Conclusion: Our case demonstrates a minimally invasive treatment for control of non-obstetric hemorrhage.
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Affiliation(s)
- Armen Eskandari
- Internal Medicine Program, Riverside County Regional Medical Center, Department of Internal Medicine, University of California Riverside School of Medicine, Moreno Valley, CA, USA
| | - Ashis Mukherjee
- Department of Cardiovascular Medicine, St. Bernardine Medical Center and University of California Riverside School of Medicine, San Bernardino, CA, USA
| | - John McHugh
- Department of Obstetrics and Gynecology, St. Bernardine Medical Center, San Bernardino, CA, USA
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42
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Ju DH, Yi SW, Sohn WS, Lee SS. Acquired uterine vascular abnormalities associated with persistent human chorionic gonadotropin: Experience at a Korean teaching hospital. Taiwan J Obstet Gynecol 2015; 54:654-9. [DOI: 10.1016/j.tjog.2014.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2014] [Indexed: 12/27/2022] Open
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43
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Endovascular management of massive post-partum haemorrhage in abnormal placental implantation deliveries. Eur Radiol 2015; 26:1620-30. [DOI: 10.1007/s00330-015-4001-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/24/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
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44
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Lee JW, Song IA, Ryu J, Park HP, Jeon YT, Hwang JW. Anesthetic management of a parturient with placenta previa totalis undergoing preventive uterine artery embolization before placental expulsion during cesarean delivery: a case report. Korean J Anesthesiol 2014; 67:279-82. [PMID: 25368788 PMCID: PMC4216792 DOI: 10.4097/kjae.2014.67.4.279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 08/12/2013] [Accepted: 08/25/2013] [Indexed: 11/10/2022] Open
Abstract
Placenta previa totalis can cause life-threatening massive postpartum hemorrhage, and careful anesthetic management is essential. Preventive uterine artery embolization (UAE) before placental expulsion was introduced to reduce postpartum bleeding in cases of placenta previa totalis. We describe the case of a 40-year-old woman (gravida 0, para 0) with placenta previa totalis and uterine myomas who underwent intraoperative UAE, which was preoperatively planned at the strong recommendation of the anesthesiologist, immediately after delivery of a fetus and before removal of the placenta during cesarean delivery under spinal-epidural anesthesia. After confirming embolization of both uterine arteries, removal of the placenta resulted in moderate bleeding. The estimated blood loss was 2.5 L, and 5 units of red blood cells were transfused. The parturient was discharged uneventfully on postoperative day 4. This case shows that the bleeding risk is reduced by intraoperative UAE in a patient with placenta previa totalis, and anesthesiologists have an important role in a multidisciplinary team approach.
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Affiliation(s)
- Jae Woo Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - In Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Junghee Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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45
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Kim JW, Kim YH, Kim CH, Cho MK, Kang WD, Kim SM, Yim NY, Song TB. Uterine artery pseudoaneurysm manifesting as delayed postpartum hemorrhage after precipitous delivery: three case reports. Gynecol Obstet Invest 2014; 78:136-40. [PMID: 25012906 DOI: 10.1159/000363742] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 05/18/2014] [Indexed: 11/19/2022]
Abstract
Precipitous delivery may lead to serious maternal and neonatal complications. Uterine artery pseudoaneurysm (UAP) is one of the causes of delayed postpartum hemorrhage. Here we describe 3 cases of UAP manifesting as delayed postpartum hemorrhage after precipitous delivery. The duration of the second stage of labor in cases 1, 2, and 3 was 15, 15, and 60 min, respectively. Excessive vaginal bleeding occurred 10, 9, and 31 days after delivery, respectively. Ultrasonogram and pelvic angiography revealed the UAP in each case and uterine artery embolization was performed. UAP may be a complication of precipitous delivery.
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Affiliation(s)
- Jong Woon Kim
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea
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46
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Rohilla M, Singh P, Kaur J, Prasad GRV, Jain V, Lal A. Uterine necrosis and lumbosacral-plexopathy following pelvic vessel embolization for postpartum haemorrhage: report of two cases and review of literature. Arch Gynecol Obstet 2014; 290:819-23. [PMID: 24947325 DOI: 10.1007/s00404-014-3310-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 06/02/2014] [Indexed: 12/01/2022]
Abstract
We are reporting two cases of uterine necrosis and lumbosacral-plexopathy in patients, who underwent pelvic vessel embolization (PVE) following postpartum hemorrhage. Embolization was performed with gelfoam slurry, polyvinyl alcohol (PVA) particles and coil in one patient and with gelfoam slurry only, in second patient. Both patients had lower limbs weakness and had persistent fever in the postembolization period. Nerve conduction study in both were suggestive of common peroneal and tibial neuropathy. An ultrasonography and computed tomography of abdomen and pelvis revealed bulky uterus with no identifiable endometrium and multiple air foci in subendometrial region suggestive of uterine necrosis, confirmed later by histology of expelled uterine mass. Lumbosacral ischemia resulting in paraparesis and uterine necrosis presenting as longstanding fever after embolization are extremely rare but overwhelming complications of embolization. Only 19 cases of uterine necrosis and <10 cases of lumbosacral plexopathy have been reported in the literature. The overall effectiveness of PVE is high in treatment of obstetric hemorrhage with low complication rate and highly selective PVE may further prevent these complication. To the best of our knowledge the co-existing uterine necrosis and lumbosacral plexopathy secondry to PVE has not been described prevoiusly in patients with postpartum hemorrhage. Both patients recovered with conservative management.
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Affiliation(s)
- Minakshi Rohilla
- Department of Obstetrics and gynecology, PGIMER, Chandigarh, 160012, UT, India,
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47
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Wan AYH, Shin JH, Yoon HK, Ko GY, Park S, Seong NJ, Yoon CJ. Post-operative hemorrhage after myomectomy: safety and efficacy of transcatheter uterine artery embolization. Korean J Radiol 2014; 15:356-63. [PMID: 24843240 PMCID: PMC4023054 DOI: 10.3348/kjr.2014.15.3.356] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/17/2014] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the safety and clinical efficacy of transcatheter uterine artery embolization (UAE) for post-myomectomy hemorrhage. Materials and Methods We identified eight female patients (age ranged from 29 to 51 years and with a median age of 37) in two regional hospitals who suffered from post-myomectomy hemorrhage requiring UAE during the time period from 2004 to 2012. A retrospective review of the patients' clinical data, uterine artery angiographic findings, embolization details, and clinical outcomes was conducted. Results The pelvic angiography findings were as follows: hypervascular staining without bleeding focus (n = 5); active contrast extravasation from the uterine artery (n = 2); and pseudoaneurysm in the uterus (n = 1). Gelatin sponge particle was used in bilateral uterine arteries of all eight patients, acting as an empirical or therapeutic embolization agent for the various angiographic findings. N-butyl-2-cyanoacrylate was administered to the target bleeding uterine arteries in the two patients with active contrast extravasation. Technical and clinical success were achieved in all patients (100%) with bleeding cessation and no further related surgical intervention or embolization procedure was required for hemorrhage control. Uterine artery dissection occurred in one patient as a minor complication. Normal menstrual cycles were restored in all patients. Conclusion Uterine artery embolization is a safe, minimally invasive, and effective management option for controlling post-myomectomy hemorrhage without the need for hysterectomy.
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Affiliation(s)
- Alvin Yu-Hon Wan
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Sangik Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Nak-Jong Seong
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 463-707, Korea
| | - Chang-Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 463-707, Korea
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48
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Kato S, Tanabe A, Kanki K, Suzuki Y, Sano T, Tanaka K, Fujita D, Terai Y, Kamegai H, Ohmichi M. Local injection of vasopressin reduces the blood loss during cesarean section in placenta previa. J Obstet Gynaecol Res 2014; 40:1249-56. [DOI: 10.1111/jog.12356] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Sosuke Kato
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Akiko Tanabe
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Kazuyoshi Kanki
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Yusuke Suzuki
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Takumi Sano
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Kentaro Tanaka
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Daisuke Fujita
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Hideki Kamegai
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology; Osaka Medical College; Osaka Japan
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49
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Puri S, Mohan B, Verma S, Verma S, Bindal V, Mishra A. Internal Iliac-Artery Balloon Occlusion in a Patient with Placenta Increta During Cesarean Hysterectomy. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Suman Puri
- Department of Obstetrics and Gynecology and Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Bishav Mohan
- Department of Cardiology, Hero DMC Heart Institute, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sumati Verma
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sugam Verma
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vidushi Bindal
- Department of Obstetrics and Gynecology and Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Atul Mishra
- Department of Surgery, Dayanand Medical Hospital, Ludhiana, Punjab, India
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50
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Arteriovenous malformation in uterine cervix during pregnancy. Obstet Gynecol Sci 2014; 57:155-9. [PMID: 24678490 PMCID: PMC3965700 DOI: 10.5468/ogs.2014.57.2.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/18/2013] [Accepted: 09/10/2013] [Indexed: 11/08/2022] Open
Abstract
As the development of Doppler ultrasonography, many cases of uterine arteriovenous malformation (AVM) have beed diagnosed. But there is no case of cervical AVM in pregnant uterus. We present a 33-year-old pregnant woman who was diagnosed with AVM of the uterine cervix during the midtrimester. Color Doppler sonography and magnetic resonance image were used for diagnosis. We performed Cesarean section because of the risk of massive bleeding from the cervical AVM at 34 weeks' gestation. This is the first case of cervical AVM during pregnancy with a successful outcome and an uneventful postpartum course.
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